51027.7 (2) I)O.§e �/ LOTNO.
r!=.No. ST T�
I 'j APPL-ICATI�`N` FOR PLUMBING PERMIT
" < I !TY OF CUPERTINO
f a ISEP 25 1967
Y o Sanitary No.
LL
0 Dat 5� 1961 Permit No
3� I
1= C+JPERTINO Fee $
1 LL
O Application is hereby made to the City of Cupertino for a permit to install plumbing
`o r pipes and/or fixtures listed on the reverse side hereof, and agrees to install said rices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
wx t
0 LL Use of Premises
00
i 3 Owner
`7/P /S /h A?G_ Address `�O
ozBy v '00- /� Address �r. " C7' �t
O CONTRACTOR, AGENT
3 < 3 �8
— m Phone
w z
o a P-09 7�g ApproveUVILLIAM D. OCNEVICH
o State License
-U PLUMBING INSPECTOR l�
FIXTURES NUMBER MAIN DRAIN
UMTS FEES UNITS FEES
Water Heeler Size
Water Closet Material @ ,
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen ink 3 Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
—
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tmy To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Materiel
Sand TrapTO PAL FEES
Urinal Fixture Fee/(. oZ 0-y
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve as Fee S
Vac Breaker
Skimmer
Filter
Permit Fee ''-I
Total Total Fee 011